Remote Utilization Review Nurse Auditor - QA/Compliance

Paycom - ATS; Mount Laurel Township (NJ); On-site; USD 45,000 - 63,000; Full time

Benefits offered by this job

Medical, Vision, Dental

Paid time off

401k

Job summary

ExamWorks is seeking a Utilization Review Nurse Auditor to perform quality utilization reviews and approve medically necessary care according to evidence-based guidelines. The role is 100% remote with a Mon-Fri schedule 8:00am-5:00pm EST, Mt Laurel, NJ area.

Requirements include an accredited nursing degree, active RN/LPN/LVN license, and 3–5 years of direct patient care. URAC and regulatory knowledge are preferred; travel is minimal.

Qualifications

• Graduate of an accredited nursing program; bachelor’s degree preferred.
• Active RN/LPN/LVN license required.
• 3–5 years direct professional patient care experience.

Responsibilities

• Perform quality utilization review for peer reviews and reports.
• Identify level, intensity and duration of care with providers.
• Document findings and evaluate medical necessity.
• Ensure reviews meet URAC and client standards and turnaround times.
• Maintain URS records and assist in client issue resolution.

Skills

Nursing knowledge

Medical terminology

Data entry (40 WPM)

Microsoft Office

Independent work

Confidentiality

Team collaboration

Adaptability under pressure

Education

Nursing degree

Tools

Microsoft Office

Job description

ExamWorks is seeking a Utilization Review Nurse Auditor to perform quality utilization reviews and approve medically necessary care according to evidence-based guidelines. The role is 100% remote with a Mon-Fri schedule 8:00am-5:00pm EST, Mt Laurel, NJ area.

Requirements include an accredited nursing degree, active RN/LPN/LVN license, and 3–5 years of direct patient care. URAC and regulatory knowledge are preferred; travel is minimal.